Co-sleeping is a practice seen throughout cultures around the world. Research and evidence on the safety of bed sharing vary, but there are a set of baby sleep area guidelines most experts agree on.
According to kidshealth.org, adults regularly share beds with infants and children in many cultures. However, in the U.S. authoritative sources like the American Academy of Pediatrics (AAP) warn against bed sharing because of the potential dangers. Some of those other countries boast lower rates of infant deaths than in the Western world even though they more widely support co-sleeping. Why could it appear bed sharing is safer in other countries than the U. S.? The discrepancy may be due to belief systems and practices or the difference in types of bedding used.
Despite warnings against bed sharing from the AAP, mentioned earlier, many U.S. parents sleep with their babies. In the longitudinal National Infant Sleep Position Study (NISP), data was collected over the course of 17 years. Results indicate about 45% of parents admit they co-sleep sometimes while 11% bed share regularly. These results may not be accurate says sociology professor Susan Stuart who reports based on her research about half U.S. families who co-sleep with infants don't tell close friends and family or their child's pediatrician that they co-sleep because of the social stigma against it.
After an extensive review of all available research on the subject, the AAP referenced above issued a revised list of infant sleep recommendations in October 2016. They say around 3500 infants die each year from deaths related to sleep and sleeping conditions. While this number may seem low compared to the estimated over 3 million annual births, these deaths represent loss that could have been prevented in some cases. Some of these deaths are explained by causes unrelated to co-sleeping like infection, disease, and trauma. Other times the cause is entrapment, suffocation, SIDS, or something unexplainable. One 2014 study conducted over eight years found that of the roughly 8,000 sleep-related infant deaths investigated during that time period, almost half involved an infant sleeping in an adult bed or on a person.
The AAP now fully supports room-sharing for infants and their primary caregiver, but cannot find enough evidence to support bed sharing as a safe practice. They recommend all babies sleep in the same room as their main caregiver at least until the age of one. Possible advantages of room sharing include:
- Easier to feed, calm, and monitor baby
- Encourages breast-feeding by making night feedings easier
- Helps baby fall asleep when she feels secure near caregiver
Possible benefits of co-sleeping, as approved by Dr. Sears, include:
- May be safer than crib sleeping
- Baby wakes less during the night
- More sound physiological factors like regular heartbeat
- Better mental health later in life
Safe Sleeping Strategies
According to the AAP and Anthropologist Dr. James McKenna, parents and caregivers looking for the safest sleep options should:
- Always place an infant flat on his back, also called supine position, to sleep
- Put baby to sleep on a firm surface with only a tightly fitted sheet
- Give baby a separate sleeping surface from others
- Keep pillows, blankets, stuffed animals, and other soft items out of baby's sleeping area
- Avoid sleeping with baby on extremely soft surfaces like a couch
- Feed baby in an adult bed in case you accidentally fall asleep, it is safer than an armchair or couch
If co-sleeping is important to you and your family, a bedside sleeper is the recommended alternative. The CPSC referenced earlier has established clear guidelines for regulations on infant bedside sleepers. These small bassinet-like structures typically attach to an adult bed along the side, keeping baby within reach. To comply with these standards, a bedside sleeper must have:
- A sturdy frame
- Fabric sides
- No more than 10 degree angled mattress
- Specific side heights
In addition, these types of baby beds pass rigorous tests to gain approval from the CPSC.
In Bed Nests
Nest-type co-sleepers are separate baby sleeping areas that sit on top of your bed. The Snuggle Me Infant Lounger features an unpadded bottom, is made in the USA from organic materials, and has a patented design that prevents baby from being able to roll over and keeps her head above the sides of the lounger. The lounger fits in between the parents in an adult bed. Another in-bed option is an Infant Sleeper which looks like a small bassinet and sits on top of your mattress. Look for sleepers with mesh sides and a firm sleeping surface for baby.
A three-sided crib, sometimes called co-sleepers, slide up right next to your bed so you can reach in the open side easily to care for a baby. Bedside cribs are usually larger than nests so your baby has more time to grow into them. For added security, use mesh bumpers rather than fabric and take care not to add extra blankets or other objects.
Unsafe bed sharing can lead to serious injury or death for an infant. The AAP says the highest risk for bed sharing with infants appears to be:
- When they are under four months old
- With preemies and low birth weight babies
- When the co-sleeping adult is a smoker, overweight, or under the influence of alcohol/drugs
- With a caregiver who is overtired
- In a bed with more than two other people
- With a caregiver who is a heavy or restless sleeper
- In a room with poor temperature control
- With a caregiver who has loose, long hair
Problems for Parents
Many parents choose bed sharing for their family, while plenty of others end up co-sleeping on occasion because they accidentally fall asleep during feedings or have a baby in high need of physical contact. Either way, sleeping with a baby in the bed can be problematic for parents too. Susan Stuart's research, mentioned above, shows most parents admit bed sharing limits intimacy for couples. However, these same parents report their view of this stunted physical relationship as temporary and worthwhile.
Other potential discomforts from co-sleeping for caregivers include:
- Fewer hours of sleep if a child moves a lot or makes a lot of noise in their sleep
- Being cold when big blankets are avoided for safety
- Difficulty ending the practice when they feel it's appropriate
A good night's sleep is vital to infant development and caregivers' peace of mind. Understand the risks and rewards associated with co-sleeping to make the most informed decision for your family.